Clinical Features of Anthroponotic Cutaneous Leishmaniasis in a Major Focus, Southeastern Iran, 1994-2014.

BACKGROUND: Cutaneous leishmaniasis (CL) is associated with a broad and complex clinical spectrum of diseases. The objectives of this study were to assess the clinical features and identification of the causative agents of CL in a well-known focus of anthroponotic CL (ACL) caused by Leishmania tropica, southeast Iran. METHODS: This study was performed randomly as a descriptive cross-sectional survey to evaluate 2000 CL patients by active and passive case-detection approaches in Kerman Province from 1994 to 2014. The ACL patients were confirmed by direct smear and 600 cases by one or a combination of intrinsic methods. RESULTS: Children aged <10 yr old were the most infected patients (P<0.001). The majority of the CL lesions were located in hands (46.3%), face (34.1%), legs (14.3%), and other parts of the body (5.3%). The mean number of lesions was 1.5 and most of the patients had single lesion (65%).Typical clinical lesions included papule (36.8%), followed by ulcerated nodule (20.7%), plaque (18.4%), and ulcerated plaque (18.5%). While among atypical clinical features, leishmaniasis recidivans (LR) (4.7%) and leishmanid (0.3%) were the dominant forms, followed by diffuse, disseminated, sporotrichoid, and erysipeloid types, 0.1% each, and then lymphedematous, lymphadenic, hyperkeratotic, paronychial, and mutilating types, 0.05% each. Based on various intrinsic methods the parasites isolated from the lesions were characterized as L. tropica. CONCLUSION: ACL due to L. tropica presents numerous cases of localized form and diverse uncommon clinical presentations, which mimic other disease conditions. Therefore, physicians should be aware of such manifestations for selecting appropriate treatment modality.

A Review of Impact of Bam Earthquake on Cutaneous Leishmaniasis and Status: Epidemic of Old Foci, Emergence of New Foci and Changes in Features of the Disease.

BACKGROUND: Global findings indicate that incidence rate of cutaneous leishmaniasis (CL) has significantly increased during the past decade, as documented in many countries. This review was aimed to evaluate the trend of CL cases in terms of demographic and clinical characteristics during a decade after the earthquake (2003-2012) compared to the corresponding period before the earthquake in Bam (1993-2003). METHODS: Direct smear preparations along with different intrinsic methods were used for detection and identification of the causative agents. RESULTS: Overall, 20999 cases of CL have occurred during the last 20 years (1993-2012), 6731 cases before and 14268 cases after the earthquake (P< 0.001). CONCLUSIONS: Following a major earthquake, several risk factors could activate epidemics of cutaneous leishmaniasis in old foci and induce emerging foci in new areas.

The severity of cutaneous leishmaniasis before and after the earthquake in Bam, southeastern Iran.

Cutaneous leishmaniasis (CL) is a major disease with significant public health concerns in Iran. The objective of this study was to compare the severity of CL among the patients before and after the earthquake in the city and suburbs of Bam, southeastern Iran. This study was carried out as a descriptive-analytical manner by house-to-house visits in 2010 in Bam, southeastern Kerman province of Iran, where a massive earthquake has recently occurred. Overall, 1,481 individuals were selected as a cluster random sampling. Suspected lesions were detected by direct smear preparation and X(2) test was used for statistical significance at P < 0.05. Overall, 1,481 individuals (mean age; 25.7 ± 17.6 years) consisting of 51.4 % males and 48.6 % females were randomly selected. 549 individuals showed history of CL; 23.4 % belonged to before and 13.7 % belonged to after the earthquake. When the overall severity in terms of location, number, size and duration of lesions was considered, the lesions were less severe in the time period after the earthquake (P < 0.05) than those before the earthquake. Cutaneous leishmaniasis is currently considered as a growing public health concern worldwide, mainly due to creation of various risk factors particularly after a major natural disaster. Possibly the establishment of the CL health clinic to serve patients and to coordinate various activities had a major role in planning control strategies and thus reduction in severity of the CL disease.

Effect of large-scale installation of deltamethrin-impregnated screens and curtains in Bam, a major focus of anthroponotic cutaneous leishmaniasis in Iran.

INTRODUCTION: Installation of deltamethrin-impregnated screens and curtains was assessed as a preventive measure against transmission of anthroponotic cutaneous leishmaniasis (ACL) by Phlebotomus sergenti in Bam, a well-known focus of ACL in Iran with a population of nearly 100,000. METHODS: This was a quasi-experiment based on official data from an ACL control program in which one section of the city with about one-quarter of the population received the intervention. In the analysis, the rest of the city was used as control. Data covered June 2007 through October 2010. RESULTS: Comparison of cumulative incidence between the intervention and control areas before and after installation indicate a significant differential reduction in the cumulative ACL incidence in the intervention area and a reversal of the relative risk, beginning four months after the completion of installation, from RR = 1.14 (95% CI:1.05-1.23) to RR = 0.84 (95% CI:0.72-0.98). Results also indicate a return to a higher cumulative relative risk, RR = 1.51 (95% CI:1.30-1.77), several months after the loss of the preventive effect. CONCLUSIONS: Findings indicate the short-term effectiveness of such preventive measures but highlight the necessity of long-term, sustainable strategies. Results also suggest that shrinkage in the human reservoir pool in response to the intervention may play a significant role in prolongation of the preventive effect beyond the insecticidal life of impregnated materials in foci of anthroponotic cutaneous leishmaniasis and possibly anthroponotic visceral leishmaniasis due to L. donovani.